What can be delegated to a charge nurse?

For nurses to be successful they must be able to address the many challenges they face every day, both clinical and administrative.

An important aspect of nursing is delegation. Delegating is a major element of directing the everyday function of nursing workflow. It is a competency by which RNs encourage and motivate others to get the job done.

Effective delegates must be knowledgeable in the leadership process. They should be a role model to others – and an inspiration.

Personnel Journey

I began my career as a CNA. As a result, the issue of delegation was something I found great difficulty in performing once I became an RN. I transitioned from being unlicensed personnel to a professional, but not only failed to recognize my role as a delegator, I also had no experience in delegation.

As a novice delegator, I was often unable to let go of a task. Therefore, I micromanaged, duplicated duties and did not plan ahead. In this new leadership role I lacked the skills necessary to effectively guide patient care, accomplish goals and lead staff.

One of my first struggles as a delegator was a terrible sense of guilt I felt when it came to delegating to CNAs. I identified with the difficulty of their job, feared being disliked and was very insecure. This caused me to take back delegated tasks and undermine my own leadership capabilities.

As a new charge nurse, I found myself feeling overwhelmed, alone and guilty. I was unable to coordinate tasks, identify goals, encourage staff, problem solve, implement plans, use staff appropriately or simply run the unit. My attempts to relate to unlicensed staff caused me to misuse clinical staff, alienate nurses and overwork myself. Because of this, employees assumed I was incompetent and unable to handle the duties of a charge nurse.

Eventually, it became evident to me that I was not an island and that I should implement the delegation process.

I recognized delegation is the act of empowering others and ensuring safe and efficient care is delivered to patients; not the negative act I thought it was. I realized that as a delegator, leader and charge nurse, I needed to earn the respect of my coworkers to be successful. I understood, as with any skill, delegation would take practice.

Today I don’t have the issues with delegation I had as a new RN, but my experience is not unique and helps me to recognize delegation as an important issue.

Significance of Delegating 

The significance of delegation in the nursing profession should not be taken lightly.

The legal and ethical implications that go along with delegation are immense. When delegation occurs, responsibility for the care is transferred to the delegate but accountability for the care remains with the delegator. This is an important point because the individual delegating an assignment must be sure they are delegating to people who are competent in the skills needed to complete the assignment.

Delegation can be seen as a teaching method for experienced to novice nurses. The skilled nurse usually delegates to the novice nurse, and recognizes the novice as one who may process information using not fully developed critical thinking skills, knowledge or planning.

In a situation where one delegates to experienced nurses, their skills and abilities must be respected and assessed. Delegation here increases their job satisfaction and develops a sense of responsibility, thereby promoting a work environment that bolsters cohesiveness and trust.

Reasons for Delegating

Delegation may take place when the manager does not have time to handle a certain task or when passing on the task solves a problem, enhances efficiency or is better use of skills. Delegation can also enhance nurses’ self-esteem by allowing them to participate in decision making and taking personal responsibility. Within the delegates’ role, one must decide when delegation would benefit the situation and the patient.

In the end, the delegator must make sure several important questions are addressed, to include:

• Does the state practice acts allow for this type of delegation?
• Would delegation benefit the patient?
• Does the delegate have the knowledge and skills to perform the delegated task?

Techniques & Barriers

The delegator must know the ability of the person to whom a task is being delegated. Jobs that are too technical or out of staffs’ scope of practice or skill range should not be delegated.

For example, if delegating to an RN, be sure it’s not a task that should or could be done by unlicensed personnel if they are available. As well, just because one holds the designation of RN does not mean they have the skills to complete the task.

When delegating, specify goals and objectives, and give staff reasons for the duty being delegated. Follow up to ensure duties are being done and that the delegate is able to complete the task and encourage staff to solve their own problems.

Barriers to delegating can present per the delegator, delegate or circumstances. For instance, barriers to the delegator may include uncertainty, fear of being disliked and lack of confidence in staff. From the delegate’s point of view, the barrier could include lack of experience, knowledge, ability and organization.

Nursing Implications

Delegation of nursing care is a crucial skill in delivering quality patient care.

It is recognized that RNs are responsible for the supervision of others to whom they have delegated tasks. The Five Rights of Delegation provide an additional resource to facilitate decisions about delegation: “right circumstances, right person, right direction/communication, and right supervision.”1

Knowledge is key for an RN trying to achieve proper delegation is knowledge. The foundation of nursing is not simply what one does with her hands; but also it is what one does with her head. Delegation is best learned through actual work with colleagues; “effective delegation requires experience as a practicing nurse.”2

RNs are experts in many areas based on their clinical practice and education, which prepares them for the complexities of delegation and healthcare delivery. They have diverse educational backgrounds which ensure them the ability to assign care in a variety of settings. They streamline patient care processes by providing holistic assessment and management of the patient’s health in partnership with a multidisciplinary team.

What’s more, delegation plays a major role in controlling healthcare costs through optimizing patient health and safety, coordination of care to reduce duplication, use of expedient processes of care, along with appropriate facilitation and efficient use of resources in alternate levels of care.

Delegation is a leadership tool needed for professional nurses to survive in their career. It enables RNs to attend to more complex patient care needs, develop the skills of others, and promote cost containment for an organization.

References for this article can be accessed here.

Regina G. Goldwire is a contributor to ADVANCE.

Depending on the role of the nurse (NP, RN, LPN), nurses can delegate tasks to the appropriate level depending on their scope of practice. A nurse can essentially delegate any time when help is needed; however, they may only do so if the task is appropriate for their skill level.

Delegating Up and Down

A nurse can delegate to a higher or lower scope. An example of delegating to a higher scope might include an RN asking an NP for a diagnosis so the RN can provide care instructions. An RN might also ask an NP to diagnose for purposes of treating. For example, if a patient arrives at urgent care complaining of a sore throat, and the RN assesses and feels the patient may have strep throat, he or she may ask the NP to examine and diagnose so the patient can be treated.

RELATED: Collaboration with Interdisciplinary Team: NCLEX-RN

Another example of a nurse delegating to a higher scope is if a charge nurse encounters problems with a coworker that is not resolved by speaking to him or her. The charge nurse may escalate the issue higher and ask the nurse manager to intervene.

Nurses may also delegate tasks to those with a more narrow scope of practice. For example, an RN might delegate PO med passes to the LPN. An LPN may delegate tasks such as ambulating or feeding a patient to the CNA.

The question of when a nurse should delegate is dependent on many factors. Usually, nurses delegate when they need help to prevent patient care delay. For example, an RN might be tied up with admitting a patient and ask the LPN to pass PO meds for him or her. In the example above involving a charge nurse and problematic coworker, the nurse delegated when action was needed that fell out of his or her scope of practice.

RELATED: How is the Scope of Practice Determined for a Nurse?

Other Instances Where Delegation Might Be Necessary

Another example of when a nurse can delegate is if a task conflicts with personal beliefs or other personal issues. For example, a nurse who strongly opposes birth control may delegate the task of birth control counseling to someone else. A nurse who may be asked to care for a patient on comfort care may ask to switch assignments if he or she has experienced a recent loss.

When delegating tasks, it's important that nurses are familiar with the scope of practice laws in their state. Asking someone to perform a task, or agreeing to do a task that is outside one's scope of practice can lead to discipline by the appropriate board of nursing and possibly by the employer. However, nurses inherently want to help, both patients as well as each other. Therefore, appropriate delegation benefits both nurses and patients.

Amanda Bucceri Androus, RN, BSN

Amanda Bucceri Androus is a Registered Nurse from Sacramento, California. She graduated from California State University, Sacramento in 2000 with a bachelor's degree in nursing. She began her career working night shifts on a pediatric/ med-surg unit for six years, later transferring to a telemetry unit where she worked for four more years. She currently works as a charge nurse in a busy outpatient primary care department. In her spare time she likes to read, travel, write, and spend time with her husband and two children.

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